| NPI | 1255548186 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS RICHARD MARTIN President 304-424-3457 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: WV 1011-4283) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2020-08-22 |